Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand,
Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Gynecol Obstet Invest. 2019;84(5):463-471. doi: 10.1159/000497484. Epub 2019 Mar 5.
To evaluate the prognostic role of metastatic lymph node (MLN), total lymph nodes (TLN) and MLN to TLN ratio in advanced-stage endometrial cancer (EMC). -Methods: EMC patients who had complete surgical staging between January 1995 and May 2017 and were in stage IIIC-IVB with pelvic and/or para-aortic nodal metastasis were identified. Data collected were age, stage, histopathology, TLN and MLN numbers, adjuvant treatment, disease status, and living status. The association of lymph node ratio (LNR), presented as a percentage of MLN to TLN, and other clinicopathologic factors with progression-free survival (PFS) and cancer-specific survival (CSS) was studied.
Among 82 patients identified, mean age was 59.5 ± 10.7 years. Majority had stage IIIC1 (45.1%) and endometrioid histopathology (65.9%). After surgery, 71 patients (86.6%) had adjuvant treatment. After a median follow-up of 29.8 months (range 0.40-257.5 months), 43 patients (52.4%) had progression or recurrences. Total of 40 patients (48.8%) were dead from cancer. By univariable analyses, significant poor prognostic factors for PFS and CSS (hazard ratios [HRs]) were age ≥50 years (2.43), stage IV (3.26), nonendometrioid histopathology (2.87), ovarian involvement (2.40), TLN (2.07), LNR (2.82), and adjuvant treatment (3.58). Only adjuvant radiation with or without chemotherapy, but none of LN features, remained significant by multivariable analyses with HR of 2.27 for PFS and 3.04 for CSS.
This study found that TLN, LNR, age, stage, histopathology, ovarian involvement, and adjuvant treatment were prognostic factors for survival in advanced-stage EMC. Only the adjuvant treatment of radiation with or without chemotherapy was the only independent significant prognostic factor.
评估转移性淋巴结（MLN）、总淋巴结（TLN）和 MLN 与 TLN 比值在晚期子宫内膜癌（EMC）中的预后作用。
本研究纳入了 1995 年 1 月至 2017 年 5 月期间接受完全手术分期且处于 IIIC 期-IVB 期（伴或不伴盆腔和/或腹主动脉淋巴结转移）的 EMC 患者。收集的资料包括年龄、分期、组织病理学、TLN 和 MLN 数量、辅助治疗、疾病状态和生存状态。研究了淋巴结比值（LNR）与其他临床病理因素与无进展生存期（PFS）和癌症特异性生存期（CSS）的相关性，LNR 以 MLN 与 TLN 的百分比表示。
在 82 名确定的患者中，平均年龄为 59.5 ± 10.7 岁。大多数患者为 IIIC1 期（45.1%）和子宫内膜样组织病理学（65.9%）。手术后，71 名患者（86.6%）接受了辅助治疗。中位随访 29.8 个月（范围 0.40-257.5 个月）后，43 名患者（52.4%）出现进展或复发。共有 40 名患者（48.8%）死于癌症。单变量分析显示，PFS 和 CSS 的预后不良因素（风险比 [HR]）有年龄≥50 岁（2.43）、IV 期（3.26）、非子宫内膜样组织病理学（2.87）、卵巢受累（2.40）、TLN（2.07）、LNR（2.82）和辅助治疗（3.58）。仅多变量分析中，接受或未接受化疗的辅助放疗与 HR 为 2.27 的 PFS 和 HR 为 3.04 的 CSS 相关，而淋巴结特征均无统计学意义。
本研究发现，TLN、LNR、年龄、分期、组织病理学、卵巢受累和辅助治疗是晚期 EMC 生存的预后因素。只有放化疗辅助治疗是唯一独立的显著预后因素。
